COLORECTAL CANCER SCREENING

About 1 in 3 Americans aged 50 to 75 years, or 23 million people, have not been screened for colorectal cancer as recommended by the US Preventive Services Task Force (USPSTF), according to new data released today by the Centers for Disease Control and Prevention (CDC).

This is a "disturbing fact," CDC Director Tom Frieden, MD, MPH, said during a media briefing. "Despite research showing that colorectal cancer screening saves lives, screening rates remain far too low."

The new data from the 2012 Behavioral Risk Factor Surveillance System survey were published in the November 5 issue of the CDC's Vital Signs, an early release of the Morbidity and Mortality Weekly Report.

Colorectal cancer is the second leading cause of cancer death in men and women in the United States, after lung cancer, yet is "preventable" through screening, Dr. Frieden said.

Current recommendations call for adults aged 50 years and older to be screened with 1 or a combination of the following tests: a fecal occult blood test (FOBT) or fecal immunochemical test (FIT) every year; flexible sigmoidoscopy every 5 years, with FOBT/FIT every 3 years; or colonoscopy every 10 years.

In 2012, 65.1% of US adults were up-to-date with colorectal cancer screening and 27.7% had never been screened. In 2002, 54% adults were up-to-date with screening, whereas in 2010, 65% were up-to-date, suggesting screening rates may be leveling off.

The 2012 data show that colonoscopy is now the most commonly used screening test (61.7%), the CDC said. Colonoscopy was used by more than 53% of the population in every state. There has been a "big increase" in colonoscopy screening in recent years, Dr. Frieden said, and "we are delighted" by that.

However, use of the other recommended tests was much lower: 10.4% for FOBT and 0.7% for flexible sigmoidoscopy in combination with FOBT/FIT.

"It's a little concerning to us that we are not seeing that uptake" in FOBTs, said Marcus Plescia, MD, MPH, director of the Division of Cancer Prevention and Control at the CDC.

"There are some data to suggest that physicians feel that colonoscopy is really the superior test, and they tend to offer that to their patients more often, and that really is not accurate," Dr. Plescia said.

The FOBT/FIT test is "equivalent to colonoscopy in saving lives when used correctly," Dr. Frieden added. "The bottom line is, the best test is a test that gets done."

Dr. Plescia said studies have shown that anywhere from 25% to 50% of patients would opt for the FOBT if given a choice. "The fact that we are seeing only 10% [use] leads us to believe that we need to do things to make sure people know that test is an option," he noted.

The report includes colorectal cancer screening data for all 50 states. Massachusetts had the highest percentage of adults up-to-date with colorectal cancer screened (76.3%), and Arkansas had the lowest (55.7%). It is worth noting, Dr. Frieden said, that states with higher rates of screening also had relatively higher rates of use of both fecal tests and colonoscopy.

"Studies show that when people are given more choices, they are more likely to get screened. We encourage healthcare providers to talk with their patients about colon cancer screening and about the choice of test," Dr. Frieden said.

In 2009, the CDC announced a plan to increase colorectal cancer screening among low-income Americans, as reported by Medscape Medical News.

The agency awarded $22 million to 22 states and 4 tribal organizations, with the goal of having 80% of the population aged 50 years and older screened by 2014 in those states.

"To achieve this goal, aggressive approaches will be needed, including more consistent promotion of both FOBT and colonoscopy as viable screening options and development of organized, population-based strategies that extend [colorectal cancer] screening efforts to settings beyond the medical provider's office," the CDC says in a statement.

Dr. Frieden noted that through the Affordable Care Act, more Americans will have access to health coverage and preventive services such as colorectal cancer screening tests, which will be available at no additional cost.

Morb Mortal Wkly Rep. 2013;62:1-8. Full text